Effects of weighted vest on bone health and body fat in middle-aged and older adults: a systematic review and meta-analysis.

UNLABELLED: This systematic review and meta-analysis of nine randomized controlled trials assesses whether weighted vests enhance bone health and reduce body fat in middle-aged and older adults. Vest plus exercise significantly increased bone mineral density and reduced body fat compared to usual activity. Adding a vest to existing exercise provided additional fat reduction but no significant benefit to bone health. BACKGROUND: Weighted vests may improve bone health and body composition in middle-aged and older adults, but evidence is heterogeneous, and additive effects beyond exercise remain unclear. OBJECTIVE: To evaluate the effects of weighted vest interventions on bone mineral density (BMD), bone turnover markers, and body fat mass in middle-aged and older adults, comparing vest plus exercise versus usual activity and versus exercise alone. METHODS: We searched PubMed, Embase, Cochrane Library, Web of Science, and Scopus from inception to March 9, 2026, and supplemented with manual searches (PROSPERO: CRD420261335254). Meta-analyses used fixed-effect models where feasible; otherwise narrative synthesis. GRADE assessed certainty. RESULTS: Nine RCTs (368 participants) were included. Vest plus exercise significantly improved femoral neck BMD (SMD = 0.59, 95% CI: 0.05 to 1.13, P = 0.03; I2 = 37%) and lumbar spine BMD (SMD = 0.73, 95% CI: 0.29 to 1.16, P = 0.001; I2 = 0%) compared to usual activity, and significantly reduced body fat mass in both subgroups (vs. usual activity: MD = -2.67 kg, 95% CI: -4.08 to -1.27, P = 0.0002; vs. exercise alone: MD = -0.73 kg, 95% CI: -1.20 to -0.27, P = 0.002). Adding a vest to exercise alone did not confer a significant BMD benefit compared with exercise alone, although this finding is derived from a single study. Body fat mass evidence was high certainty; other outcomes were low to moderate. CONCLUSIONS: Vest plus exercise improves BMD and reduces adiposity versus usual activity. As an exercise adjunct, it yields additional fat loss without confirmed skeletal benefit, based on limited data. Weighted vests present a viable option for generally healthy middle-aged and older adults, although further research is needed to determine whether similar effects occur in individuals with restricted exercise capacity.